Tuesday, 9 December 2014

NEW White Paper – How
Specials can deliver value to the NHS without compromising patient safety.

The APSM, Association of Pharmaceutical Specials
Manufacturers, has launched a White Paper which for the first time attempts to
attribute an economic value to the provision of unlicensed medicines within the
NHS. The paper takes a series of typical
patient scenarios where a Special is indicated and then identifies the
potential cost to the NHS of attempting to meet patient need with a lower cost,
or higher risk alternative. In all of
these cases this additional cost has exceeded that of providing a special and
sourcing it according to established guidance.

The White Paper was commissioned in the light of growing
concern about cost pressures leading to higher risk practice in the supply
chain.

Striking the balance
between cost and quality

Specials account for approximately 1% of prescription costs
and in recent years, as part of overall pressure on NHS budgets, the cost of
Specials has come under scrutiny. Costs
are regulated by Tariff and in the last 3 years the overall cost of specials
has reduced by almost 30%.

Specials must be produced to pharmaceutical standards, but
there are concerns that increased pressure to reduce cost could be compromising
quality through sourcing lower cost supply, or even reluctance to prescribe a Special
when required.

In a recent survey amongst GPs, 54% said they had been asked
by their CCG to reduce prescribing of Specials1. In the same survey, 45% of GPs stated that
they were happy to prescribe a licensed medicine with instructions to the
patient to split or crush capsules or tablets – compared with just 29% in
2012. The risks of tablet crushing are well
documented and, the APSM believes, is just one example of how continued
pressure to reduce cost could be forcing prescribers and dispensers to opt for
higher risk options for meeting patient need.

In this respect the APSM strongly supports the cautionary comments
of the British Medical Association recently in relation to the doctor’s role in
optimising the limited resources of the NHS.
"While staff and
management should work closely to maximize the use of the NHS's very limited
resources, a doctor's primary duty is to their patient, and it is vitally
important that decisions around patient care are around clinical value."2

This White Paper sets out to explore the true cost of
selecting a higher risk alternative and how a well regulated and high quality
Specials sector can provide value to the NHS.
Through a series of case study scenarios, it looks at what happens when
patient need and safety is compromised to the extent that there is additional
cost incurred to the NHS. In all of
these cases this additional cost has exceeded the initial cost of providing a Special
in line with the established guidance.

There is robust guidance and regulation in place to ensure
that Specials should only ever be prescribed when there is no alternative to
meet patient need. However, when a Special is
indicated, it is clear that attempts to cut cost in the supply chain are likely
to result in increased demands on the NHS budget.

Says, APSM Chair, Sharon Griffiths.
‘There is regulation and guidance to prevent unnecessary prescribing of
a Special and as an industry we have a duty to support this. However, when a special is indicated, we’re
concerned that there is too much pressure on cost and not enough emphasis on
patient safety.’

Cost is an inevitable fact of life and although it’s difficult to
quantify the benefit to every patient of every individual special that is
provided, as an industry, we felt we needed to find a way to demonstrate the
value of specials and define what a high quality supply chain means to the NHS
and to the patient. We believe this
White Paper provides a very clear justification of that value.’